Surgical Guide Transcript
Hello there, it is my pleasure to provide you some practical information to help you through your surgical procedure!
It is completely normal to feel nervous about the unknown. Together, we will explore how to best prepare, what to expect, as well as the best way to become involved in your recovery of your upcoming surgery.
LEADING UP TO YOUR SURGERY
All information presented is recommended and supported by a critical review of the medical literature, including the recent recovery pathway called ERAS, standing for Enhanced Recovery After Surgery.
When compared with traditional operative care, using aspects of ERAS has been associated with decreased pain, length of stay, use of nursing time, while simultaneously improving patient satisfaction and quality of life, thus enabling you to recover more quickly and resume routine activities in a more timely fashion compared to standard surgical care. Benefits have been reported for patients undergoing colorectal procedures.
Planning ahead of your procedure and going in as healthy as you can will have a positive influence on your procedure and recovery. Pre-operation information and preparation can reduce fear, fatigue, and pain while speeding up the recovery process.
Like a marathon, a surgery is something that is best approached when one is prepared and takes the appropriate measures to recover from such a physically and mentally draining day. You should spend the time before the procedure being as active as you can (whether that involves going for short walks or exercising), eating right, and getting a good night’s sleep. If you smoke, you would benefit to stop as soon as possible, because smoking can cause problems with breathing and recovery from surgery. If you drink alcohol, you may want to moderate your alcohol consumption for a few weeks prior to surgery, and avoid any consumption 24 hours prior to surgery, as lowered alcohol consumption can reduce post-operative complication rates.
Based on ERAS, and to be confirmed by your health care team
- Consumption of solid foods up to six hours prior to surgery, clear liquids up to two hours prior, and encourages preoperative carbohydrate loading (a strategy utilized by marathon runners to maximize the storage of energy in their muscles and liver).
- You can drink clear liquids such as water, black tea, black coffee or apple juice up to 2 hours leading to surgery, but NO liquids such as milk or orange juice are allowed.
- preoperative carbohydrate loading can be started the night before surgery, as it is recommended you drink 800 mL of apple juice at 10 pm (3-4 glasses) and 400 mL of apple juice 2 hours prior to your surgery which will aid improve recovery, as this has been found to be significantly correlated with a reduction in length of hospital stay by about 1 day in patients undergoing major abdominal surgery.
- before surgery, patients should shower or bathe their full body with 4% chlorhexidine gluconate soap at the night before and morning of their surgery as it has been associated with a lower risk of surgical site infection for patients undergoing abdominal procedures
- do not shave the region where you will be operated on as this will be done for you at the hospital to avoid any irritation.
THE DAY OF SURGERY,
- Try to Bring a family member, friend or someone to assist you. You won’t be allowed to drive after outpatient surgery, or even after a few days in the hospital, primarily if you’re taking pain medication. Plan to have someone take you home.
- Wear comfortable clothing. Wear or bring loose-fitting clothing. Your body might be sore or swollen from surgery, or you may have bulky bandages over your incisions. Leave jewelry and valuables at home. Toothpaste/brush, pajamas, denture cup if necessary, and any medications that you take regularly in a labeled pharmacy container approved by your healthcare provider. You may also choose to bring compression stockings to wear on your journey home.
On the day of the surgery, the health care provider who will admit you, will likely check your temperature, blood pressure, pulse and breathing, review your medication and help you get ready. You will receive some medications before and after surgery to improve pain control. Frequently an intravenous tube, called an IV, will be placed into a vein in your arm, to allow you to get fluids and medication. When you are ready, someone will help you onto a stretcher and take you to the holding area, and then to the operating room.
Immediately after your operation (Day 0)
Postoperative ERAS elements typically focus on pain management, bowel function, diet, and patient mobilization.
When you wake up after surgery, you may feel cold and experience pain in your abdomen or in your pelvis. If you had laparoscopic or robotic surgery, you may also feel transitory pain in your shoulder. This pain is from the carbon dioxide gas that is used to expand your abdomen during this type of surgery. The sensitivity to pain is different for each person. If you are having pain or nausea, tell your nurse, who will help you get more comfortable and give you medication.
You may receive a stoma bag during your surgery, which is a small opening in your abdomen to help get rid of wastes. If this is the case, you will meet a stoma nurse during your time in the hospital who will teach you how to clean and maintain your stoma bag
If your surgery is more than 3-4 hours long, you may wake up with a urinary catheter in place until the time you are able to mobilize out of bed and make your way to the bathroom.
Your throat may feel sore from the tube used to help you breathe during surgery. If your mouth is dry, you may have some ice chips when you are fully awake. Feeling stiff or achy is also normal at this time. These feelings will go away when you can move around more. Some women feel sad or “blue” after surgery. These feelings are normal. As your body heals and you are able to resume your activities, these feelings will lessen. Please talk about these feelings with your nurse, a friend or someone in your family. If you feel overwhelmed by these feelings or they do not lessen over time, please get help from a health care provider.
Following your operation, when you wake up, it is important that you perform deep breathing
exercises. Breathe in deeply through your nose and relax the air out through your mouth, undertake this at least five times an hour. You will receive an incentive spirometer, which is a device used to help you open up your airways after surgery. When you feel like coughing, don’t hold back but try holding your abdomen to control the pain.
The medical staff may help you out of bed after your operation. You should try to spend up to two hours out of bed on the day of your operation. If you feel faint or dizzy, call the nurse to help you get back to bed.
Early refeeding has been shown to be associated with an accelerated return of bowel function and reduced length of hospital stay with no increased rates of complication. A proper diet will allow you to maintain normal blood sugar levels, which will help you recover faster and decrease the risk of postoperative infections. A recommended diet is one which is “diet as tolerated” strategy or a “standard diet”, allowing a patient to decide what they will eat immediately postoperatively and is started soon after surgery. It is important to underline that diet as tolerated, or standard diet is not equivalent to force-feeding, and that patients should eat based on how they feel.
You may feel gas pains in your stomach or abdomen. This is normal as your bowels start to work again. Walking, rocking, or using hot packs, can relieve gas pains. You may need a stool softener, a laxative or an enema to enhance a bowel movement. Passing gas, or having a bowel movement will often take away gas pains. Walking around, gum chewing, and having some caffeinated beverages can help make bowel movements come more quickly.
THE FOLLOWING DAYS
It is important to stay hydrated during your recovery. You can drink a variety of non-fizzy drinks whilst in hospital. High protein, high energy drinks are ideal after your operation to help your body to heal, reduce the risk of infection and help your overall recovery. Try to drink two or more each day.
On each day after your surgery it is advised that, provided you feel well enough, you sit in the chair for a total of six hours, with intermittent rests on the bed as needed. Your medical team will place compression stockings on in order to decrease the chance of blood clots in your legs while you are lying in bed. You should also aim to do some lower extremity exercises, such as bending your knees, rotating your ankles, and pointing your feet up and down. Once you are capable, you should aim to walk along the ward corridor as much as possible. Being in an upright position, getting out of bed, and walking will help improve breathing, increase muscle strength, and decrease the chance of clots in your chest and legs.
Following your surgery, the healthcare team might suggest that you receive medication to prevent blood clots for up to 28 days after surgery, this is presently given in the form of a small daily injection that can be administered by you, family member or a nurse
Criteria for discharge for any patient undergoing colorectal surgery include tolerance of a regular diet, ambulation (ability to move), the ability to go to the bathroom, appropriate pain control and no signs of complications.
It is worthwhile to plan in advance for your discharge. You may require someone to help for a few weeks. Although it is not indispensable, some people feel more confident to go home if a friend or family member can stay with them for a short period of time.
POST HOSPITAL RECOVERY
It is not unusual to suffer abdominal pains during the first week following surgery. The pain usually lasts for a few minutes and goes away between the spasms. If you have severe pain or have a fever and feel generally unwell within two weeks of your operation date, you should immediately contact a health care provider.
It is not unusual for your wounds to be slightly red and uncomfortable during the first one or two weeks. Please contact a health care provider if your wounds become inflamed, painful, swollen, or start to discharge fluid
A balanced, varied diet is recommended. Try eating three or more times a day. You may find that some foods upset you and cause loose bowel motions. If that is the case you should avoid those
foods for the first few weeks following your surgery. If you are finding it difficult to eat it is still important to obtain an adequate amount of protein and calories to help your body heal. You may benefit from having three to four nourishing, high protein, high calorie drinks to supplement your food. If you are suffering from diarrhea it is important to replace the fluid loss and to drink extra fluid. If you are losing weight without trying to or are struggling to eat enough, you should seek medical advice.
Walking is usually encouraged starting the day following your operation. You should plan to undertake regular exercise several times a day and gradually increase this during the four weeks following your operation until you are back to your normal level of activity. The main restriction on exercise is usually not to undertake heavy lifting (generally not more than 5 – 10 lbs) and contact sports until six weeks following your surgery. In addition, if you are planning to restart a routine exercise such as jogging or swimming you should usually wait until at least two weeks after your operation and start gradually. Common sense will guide your exercise and rehabilitation. In general, if the wound is still uncomfortable, modify your exercise. Once the wounds have completely healed you can normally undertake most activities.
You should not drive until you are confident that you can drive safely. A good yardstick for this is when you have got back to most of your normal activities and not on strong painkillers. Usually, this will be within two to four weeks of surgery. It is important that any pain has resolved sufficiently and that you are not taking any medication that would interfere with your ability to react appropriately in the event of an emergency on the road.
You should consider taking up your hobbies and activities as soon as possible again after surgery. It enables you to maintain your activity and will benefit your recovery. You should not need to restrict these unless they cause significant pain or involve heavy lifting.
It is frequent to feel low energy levels following surgery and anesthesia. It is important to mix activities with some rest as needed but to get out of bed each day and get dressed if possible.
To enhance your recovery you will benefit to return gradually to normal as quickly as possible. This means that you need to actively participate in your recovery by walking, eating and drinking. Each day you should feel some improvement but do ask your healthcare provider if you are worried about something. You can refer to the list of products on Precare.ca for your specific surgery as an example on what you need for your surgical preparation and recovery. It is our hope that this video makes you feel more confident about what’s ahead. On behalf of the Precare team, we wish you the best on your journey.